992 (44 USC 2107 Note). Caset: Nw
bib | Date 4-15-21)

AGENCY

RECORD NUMBER
RECORDS SERIES
AGENCY FILE NUMBER

Date
Page

JFK ASSASSINATION SYSTEM
IDENTIFICATION FORM

AGENCY INFORMATION

INSCOM/CSF

194-10001-10496

FOREIGN PERSONNEL AND ORGANIZATIONS
AB632604W - PAGES 76-79

09/30/98
1

ORIGINATOR
FROM

TO

TITLE

DATE

PAGES
SUBJECTS

DOCUMENT TYPE
CLASSIFICATION
RESTRICTIONS
CURRENT STATUS

DATE OF LAST REVIEW
OPENING CRITERIA
COMMENTS

DOCUMENT INFORMATION

EDIFANIO ROMERO-DELGADO

DD FORM 398 -. STATEMENT OF PERSONAL HISTORY
01/18/63.

4

ROMERODELGADO, EPIFANIO

PAPER, TEXTUAL DOCUMENT
UNCLASSIFIED

3

RELEASED WITH DELETIONS
03/07/95

NW 88613 Docid:34528399 Page 1

els CR #53348
STATEMENT Otys t,

INSTRUCTIONS: Read the certification at the end 5 im before entering the required data. Print or type all
answers. All questions and statements must be completed. If the answer is “None,” so state. Do not misstate or omit material
fact since the statements made herein are subject to verification. If more space is needed, use the Remarks section, item 20, and
attach additional sheets if necessary. The information entered hereon is for official use only and will be maintained in confidence.

i} int) FIRST NAME—MIDDLE NAME-~MAIDEN NAME (Jf any)—LAST NAME
2. STATUS

MR,

Oo)
oO Miss Edifanio ROMERO-Delgado [x | CIVILIAN MILITARY ON ACTIVE DUTY

3. ALIAS(ES), NICKNAME(S). OR CHANGES IN NAME (Other than by marriage) 4. PERMANENT MAILING ADDRESS

Piche 1140 SW Sta

' 5. DATE OF BIRTH (Day, month, year) PLACE OF BIRTH (City, County, State, and-Country) PLACE CERTIFICATE RECCRDED

21 Jan 1936 Candelario, PinardelRio, Guba Candelario , Pinardel#io, Guba

RACE HEIGHT WEIGHT COLOR OF EYES COLOR OF HAIR SCARS, PHYSICAL DEFECTS, DISTINGUISHING MARKS

Cau 66 165 Brown -| Brown NONE
6. DO YOU HAVE A HISTORY OF MENTAL OR NERVOUS DISORDERS? [J YES [No ARE YOU NOW OR HAVE YOU EVER BEEN ADDICTED TO THE USE OF HABIT FORMIN RUGS SUCH AS
NARCOTICS OR BARBITURATES? o YES NO ARE YOU NOW OR HAVE YOU EVER BEEN A CHRONIC USER TO EXCESS OF ALCOHOLIC BEVERAGES? O YES NO IF THE
ANSWER TO ANY OF THE ABOVE IS "YES." EXPLAIN IN ITEM 20.

7. U.S. NATIVE #F NATURALIZED. CERTIFICATE NO. IF DERIVED, PARENTS’ CERTIFICATE NO(S), DATE, PLACE, AND COURT
CITIZEN

YES
NO

s

REGISTRATION NO. NATIVE COUNTRY DATE AND PORT OF ENTRY DO YOU INTEND TO BECOME

A13 108 636 Cuba 21 Sept 1962 Texas . AU. S, CITIZEN?
MILITARY SERVICE

ARE YOU PRESENTLY ON ACTIVE OUTY IN THE U. S. ARMED FORCES DRAWING FULL PAY? | vesX] NO IF ““YES,"" COMPLETE THE FOLLOWING: N

GRADE AND SERVICE NO. SERVICE AND COMPONENT ORGANIZATION AND STATICN DATE CURRENT ACTIVE
SERVICE STARTED

ARE YOU PRESENTLY A MEMBER OF A U.S. RESERVE OR NATIONAL GUARD ORGANIZATION? O YES ibe NO IF “YES,"* COMPLETE THE FOLLOWING:
GRADE AND SERVICE NO. SERVICE AND COMPONENT ORGANIZATION AND STATION OR UNIT AND LOCATION

HAVE You PREVIOUSLY SERVED TOURS OF EXTENDED ACTIVE DUTY, DRAWING FULL PAY, FROM WHICH YOU WERE DISCHARGED OR SEPARATED TO CIVILIAN STATUS? [_} YES x NO
IF ''YES."' COMPLETE THE FOLLOWING:
SERVICE COMPONENT [| FROM (Date) TO (Date) TYPE DISCHARGES OR SEPARATIONS—GRADE AND SERVICE NO.

EDUCATION (Account for all civilian schools and military academies. Do not include service schools)

MONTH AND YEAR GRADUATE
NAME AND LOCATION OF SCHOOL, DEGREE

Escuela Publica San Cristobal

FAMILY (List in order given, parents, spouse, guardians, stepparents, foster parents, parents-in-law, former spouse(s) (if divorced give date
and place), children, brothers and sisters, even though deceased. Include any others you resided ‘with or with whom a close relationship
existed or exists. If the person is not a U.S. citizen by birth, give date and port of entry, alien registration number, naturalization certificate
number and place of issuance.)

RELATION AND NAME DATE AND PLACE OF BIRTH PRESENT ADDRESS. IF LIVING U.S. CITIZEN

FATHER date unknown
Felipe Romero Conzolaciondel Sur , Guba DECEASED

MOTHER (Maiden name) date unknown Finca Sabana La Mar

Sagunda Delgado " " a SanCristobalPinardelRio , Cuba
SPOUSE (Maiden name) | 1 Feb 1 6 Candelaria

Iida Martinez ; o, Cuba
OTHER (Specify) lay 19RD See Cristobal

turo Romero ‘imar delRio, Guba
‘inca Sabana Ia MarSan

CristobalPinardelRio fyba

NFEGETS Dieias SapGREP EJBOUS EDITIONS AhE OBSOLETE. Exception to Standard Form 86
p34 age 2 Approved by Bureau of the Budget June 1960

Pmnt vy

OTHER RELATIVES AND ALIEN FRIENDS LIVING IN FOREIGN COUNTRIES (List grandparents, first cousins, aunts, uncies,

brothers- and sisters-in-law, and other persons with whom a close relationship existed or exists)

RELATIONSHIP AND NAME ADDRESS

CITIZENSHIP

Juan Delgado |

Pedro Delgado
Francisco Delgado

Niebe Delgado

Maria Delgado

FOREIGN TRAVEL (Other than as a direct result of United States military duties)

COUNTRY VISITED

PURPOSE OF TRAVEL

AND YEAR

EMPLOYMENT (Show every employment you have had and all periods of unemployment)

DID ANY OF THE ABOVE EMPLOYMENTS REQUIRE A SECURITY CLEARANCE? [[] YES %] NO DO YOU HAVE
ANY FOREIGN PROPERTY OR BUSINESS CONNECTIONS, OR HAVE YOU EVER BEEN EMPLOYED BY A FOREIGN
GOVERNMENT, FIRM, OR AGENCY? [7] YES [ENO HAVE YOU EVER BEEN REFUSED BOND? OO Yes
§d NO IF THE ANSWER TO ANY OF THE ABOVE IS "'YES,"’ EXPLAIN IN ITEM 20.

M CREDIT AND CHARACTER REFERENCES (Do not include relatives, former employers,
nited States or its Territories.

NAME YEARS STREET AND NUMBER
(List 3 credit and 5 character) KNOWN (Business address preferred)

SOCIAL SECURITY NO.

463-74—2051

or persons living outside the

CITY

|
|
ee
Gustado Acosta 0

: ado Aco a

CHARACTER CREDIT

REMARKS.

ed
U.S, GOVERNMENT PRINTING OFFICE : 1960 0—573450

NW 88613 Docld:34528389 Page 3


LIST ALL RESIDENCES FROM 1 JANUARY 1937

TYPE

(Social, fraternal, professional, etc.)

NAME AND ADDRESS

ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF THE COMMUNIST PARTY U, S. A., OR ANY COMMUNIST ORGANIZATIONS ANYWHERE?
ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF A FASCIST ORGANIZATION?

ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF ANY ORGANIZATION, ASSOCIATION, MOVEMENT, GROUP OR COMBINATION OF PERSONS WHICH ADVOCATES THE
OVERTHROW OF OUR CONSTITUTIONAL FORM OF GOVERNMENT, OR WHICH HAS ADOPTED THE POLICY OF ADVOCATING OR APPROVING THE COMMISSION OF ACTS OF FORCE
OR VIOLENCE TO DENY OTHER PERSONS THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES, OR WHICH SEEKS TO ALTER THE FORM OF GOVERNMENT OF
THE UNITED STATES BY UNCONSTITUTIONAL MEANS?

ARE YOU NOW OR HAVE YOU EVER BEEN AFFILIATED OR ASSOCIATED WITH ANY ORGANIZATION OF THE TYPE DESCRIBED ABOVE AS AN AGENT, OFFICIAL, OR EMPLOYEE?

ARE YOU NOW ASSOCIATING WITH, OR HAVE YOU ASSOCIATED WITH ANY INDIVIDUALS, INCLUDING RELATIVES, WHO YOU KNOW OR HAVE REASON TO BELIEVE, ARE OR
HAVE BEEN MEMBERS OF ANY OF THE ORGANIZATIONS IDENTIFIED ABOVE?

HAVE YOU EVER ENGAGED IN ANY OF THE FOLLOWING ACTIVITIES OF ANY ORGANIZATION OF THE TYPE DESCRIBEO ABOVE: CONTRIBUTION(S) TO, ATTENDANCE AT OR
PARTICIPATION IN ANY ORGANIZATIONAL. SOCIAL. OR OTHER ACTIVITIES OF SAID ORGANIZATIONS OR OF ANY PROJECTS SPONSORED BY THEM: THE SALE, GIFT, OR DIS-
TRIBUTION OF ANY WRITTEN, PRINTED, OR OTHER MATTER, PREPARED, REPRODUCED, OR PUBLISHED, BY THEM OR ANY OF THEIR AGENTS OR INSTRUMENTALITIES?

IF “YES,” DESCRIBE THE CIRCUMSTANCES, ATTACH ADDITIONAL SHEETS FOR A FULL DETAILED STATEMENT. iF ASSOCIATED WITH ANY OF THE ABOVE ORGANIZATIONS, SPECIFY NATURE
AND EXTENT OF ASSOCIATION WITH EACH, INCLUDING OFFICE OR POSITION HELD. ALSO INCLUDE DATES. PLACES, AND CREDENTIALS NOW OR FORMERLY HELD. !F ASSOCIATIONS HAVE
BEEN WITH INDIVIDUALS WHO ARE MEMBERS OF THE ABOVE ORGANIZATIONS, THEN LIST THE INDIVIDUALS AND THE ORGANIZATIONS WITH WHICH THEY WERE OR ARE AFFILIATED.

18. HAVE YOU EVER BEEN DETAINED, HELD, ARRESTED. INDICTED OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING. OR CONVICTED. FINED. OR IMPRISONED OR
PLACED ON PROBATION, OR HAVE YOU EVER BEEN ORDERED TO DEPOSIT BAIL OR COLLATERAL FOR THE VIOLATION OF ANY LAW, POLICE REGULATION OR ORDINANCE (excluding
minor traffic violations for which a fine or forfeiture of $25, or less was imposed)? {tNCLUDE ALL COURT MARTIALS WHILE !N MILITARY SERVICE. ¥) YES oO NO

IF “YES,” LIST THE DATE, THE NATURE OF THE OFFENSE OR VIOLATION, THE NAME AND LOCATION OF THE COURT OR PLACE OF HEARING, AND THE PENALTY IMPOSED OR OTHER
DISPOSITION OF EACH CASE.

Has been in Jail without trial in the G2 of Pinar del Rio,Qyba about 18 days from
22 April. 1961 for political reasons.

19. ARE.THERE ANY INCIDENTS IN YOUR LIFE NOT MENTIONED HEREIN WHICH MAY REFLECT UPON YOUR LOYALTY TO THE UNITED STATES OR UPON YOUR SUITABILITY TO PERFORM
THE DUTIES WHICH YOU MAY BE CALLED UPON TO TAKE OR WHICH MIGHT REQUIRE FURTHER EXPLANATION? oO YES i NO IF YES." GIVE DETAILS

NW/ 688613 Docid:34528389 Page 4
H

19. ARE,THERE ANY INCIDENTS IN YOUR LIFE NOT MENTIONED HEREIN WHICH MAY REFLECT UPON YOUR LOYALTY TO THE UNITED STATES OR UPON YOUR SUITABILITY TO PERFORM
THE DUTIES WHICH YOU MAY BE CALLED UPON TO TAKE OR WHICH MIGHT REQUIRE FURTHER EXPLANATION? ([_] YES *) NO IF “YES."’ GIVE DETAILS

20. REMARKS

ITH #10

Fernando Romero B San Cirtobal Pinardel tio .  $an Cristobal Finardelio, Gyba
FincaSantaAmaliaSabanalaMar ; . 40,4

Sabina Romero 5

Augustina RomeroS

1 CERTIFY THAT THE ENTRIES MADE BY ME ABOVE ARE TRUE, COMPLETE, AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AND ARE MADE IN
GOOD FAITH. | UNDERSTAND THAT A KNOWING AND WILLFUL FALSE STATEMENT ON THIS FORM CAN BE PUNISHED BY FINE OR IMPRISONMENT OR BOTH
(See U. S. Code, title 18, section 1001)

SIGNATURE OF PERSON COMPLETING FORM

. < dw
TYP) D NAME AND A ADDRESS OF WITNESS.
.
. 3 3 1 3 : a

f

RECORD OF PRIOR CLEARANCES

DATE OF CLEARANCE TYPE OF CLEARANCE AGENCY THAT COMPLETED INVESTIGATION

REMARKS.

—————
U.S, GOVERNMENT PRINTING OFFICE :; 1960 O—573450

NW 88613 Docid:34528389 Page 5

